Arlington, VA — The Armed Forces Research Institute of Medical Sciences (AFRIMS) in Thailand ran the world’s largest HIV vaccine trial from 2003-2009.
The Naval Medical Research Unit 3 in Egypt detected the first human case of Avian influenza in Egypt in 2006.
Other invaluable contributions to world health from DoD labs include the first vaccine for Japanese encephalitis virus, the first isolation of the Rift Valley Fever virus, the first identification of new strains of dengue fever in Peru and the demonstrated efficacy of several drugs to treat and prevent malaria.
So, why are these labs “undervalued” outside of the research community, “poorly appreciated” by Congress and the executive branch and constantly beset with funding uncertainty?
A newly-released report, “The Defense Department’s Enduring Contributions to Global Health — The Future of the U.S. Army and Navy Overseas Medical Research Laboratories” set out to answer those questions. The Center for Strategic and International Studies (CSIS) examined DoD medical research laboratories in Cambodia, Egypt, Kenya, Peru and Thailand, finding that the labs have made important contributions to public health yet remain “surprisingly under recognized and undervalued.” The CSIS team of researchers was led by retired Army Lt. Gen. James Peake, who also is a former U.S. Army Surgeon General and former VA Secretary.
More Funding, Recognition
Because their work has been instrumental in controlling diseases around the world (e.g., demonstrating the efficacy of malorone, primaquine and weekly tafenoquine to treat malaria), the labs are perceived as important assets by their host countries, the report stated.
The labs include the U.S. Army Medical Research Unit in Nairobi, Kenya; the Armed Forces Research Institute of Medical Sciences in Bangkok; the U.S. Naval Medical Research Unit 3 in Cairo; NAMRU-6 in Lima, Peru; and NAMRU-2 Pacific, temporarily headquartered at Pearl Harbor, Hawaii. A sixth laboratory, U.S. Army Medical Research Unit Europe, in Heidelberg, Germany, conducts psycho-social research; and the precursor to a new U.S. Army laboratory, the Central Public Health Reference Library, opened in March in Tbilisi, Georgia.
“Through their extensive capacity-building activities, their reliance on locally-hired research personnel and their focus on diseases of local relevance, the Army and Navy laboratories have become integrated in the public-health efforts of their host nation,” according to the report.
Yet, the authors also said these labs have “too few champions” within the upper ranks of Army and Navy Medicine and in the senior leadership of DoD and Congress.
“There are a number of reasons for this limited domestic support,” the authors wrote. “The laboratories lack a targeted and strategies plan for outreach and communications; and their remote locations, small number of personnel, and diminutive fraction of the U.S. defense budget make it all the harder to garner attention and cultivate champions in Washington.”
Lack of communication about the labs’ “success stories” contribute to “persistent funding uncertainty” and put the facilities at risk of having to cut back research programs, according to the report. The budget of four of the most active overseas labs, not including personnel costs, was in aggregate $100 million, and that is contingent on a variety of sources including grants, cooperative research agreements with federal entities, universities and private industry and competitive proposals to DoD sponsors, study authors pointed out.DoD Overseas Labs Do Invaluable Research, Yet Remain Undervalued, Underfunded Cont.
Labs Need More Visibility
Peake, who presented recommendations from the report, said that Congress needs to provide “predictable and sustainable funding for the research mission.” He also recommended that the labs and their leadership do more to increase their visibility to Congress and others in Washington.
“Working with DoD legislative liaison folks, it is quite clear that senior military medical leaders could highlight their activities to Congress and the importance of their work,” said Peake.
The report also suggested that the labs could better communicate by reaching out to current and prospective business, university and foundation partners, as well as other federal government agencies, through user-friendly annual compendiums of successes that could make a quantitative case for the labs.
“The laboratories need clearer metrics — the number, for example of U.S. and allied soldiers inoculated or treated with products the laboratories developed,” the report stated.
In addition, it said, the labs should develop a “unified internet and social media strategy, including specialized media training for officers in each laboratory.”
Jonathan Woodson, assistant secretary of defense for health affairs, who spoke at the report’s release, said the study provided an “independent and an expert voice” on this issue. He acknowledged that getting the word out about what the labs are doing is important.
“We have got to put that out in front of everyone that for relatively little dollars, we get a huge benefit,” he said. “Not only in terms of protecting the citizenry of this nation and military folks specifically, but the additive value to world is just incredible.”
He acknowledged that troops often serve “silently” and in the background and so their value and contributions are not known widely. However, highlighting progress in the labs is important in order to create “the balance in terms of priorities.”
Another challenge cited in the report was constant staff turnover that can be disruptive to research. Overseas tours of duty for military researchers may only last two to three years.
Peake and his colleagues recommended that the Army and Navy modify personnel requirements for medical researchers and allow tours of duty at the overseas labs to be five years or longer, to minimize the disruption by staff turnover and accelerate the development of medical products. In addition, the team also recommended that a “dedicated career track in medical research” would help the labs continue to attract “top scientific talent.”